UTI infection lecture notes

Question 1

UTI definition

Answer 1

Combination of clinical features and the presence of bacteria in the urine

Question 2

What are infections of the lower tract?

Answer 2

UTI
Cystitis

Question 3

What is infection of upper tract called?

Answer 3

Pyelonephritis

Question 4

What is pyuria?

Answer 4

Presence of leucocytes in the urine
Associated with infection

Question 5

What are the most common pathogens causing UTIs?

Answer 5

E. Coli (more than 50%)
Proteus
Klebsiella
Entercocci
Staph. saprophyticus
Staph aureus
Pseudomonas aeruginosa

Question 6

Symptoms of upper urinary tract infection

Answer 6

Loin pain
Back/flank pain
Fever
haematuria

Question 7

What are symptoms of lower urinary tract

Answer 7

Dysuria
Confusion

Question 8

Diagnosis of UTI

Answer 8

Urine dipstick
MC+S

Question 9

What will a dipstick / urinalysis look at?

Answer 9

Blood
Protein
pH
Glucose
Ketones
Leucocytes
Nitrates

Question 10

What different types of urine samples are there?

Answer 10

MSU (midstream urine) - gold standard

CSU (catheter specimen urine)

Clean catch (young children/disabled)

Bag urine

SPA aspirate

Early morning urine (for detecting TB as highest concentration of bacilli)

Question 11

What is being investigated though microscopy

Answer 11

White blood cells
Red blood cells
Casts
Bacteria
Epithelial cells

Question 12

What levels of WBCs suggests infection?

Answer 12

> 10^5 wbc/ml

Question 13

What kinds of infections show high WBCs but no bacteria in urine sample?

Answer 13

TB

Non-culturable organisms:
Candida
mycobacteria
mycoplasma
schistosomiasis

Renal calculi (renal stones)
Neoplasm
Catheter (irritation)

Question 14

How are UTIs managed?

Answer 14

First line: antibiotics (as narrow spectrum as possible

Nitrofurantoin (not suitable for pregnant ladies)

Question 15

Patients older than __ should not be treated if they have asymptomatic bacteriuria

Answer 15

65

Question 16

The newer antibiotics, Fosfomycin is a broad spectrum antibiotic distributed in a sachet which prevents the formation of a component of bacterial ___ ___.

Answer 16

cell wall

Question 17

What kind of bacteria is staphylococcus saprophyticus? (gram and shape)

Answer 17

Gram positive cocci

Question 18

True or false: You don’t diptstick catheter samples

Answer 18

True
Already know will be WBCs and antibiotics

Instead send a fresh sample not from bag.

Also don’t do microscopy on catheter sample

Question 19

How many hours post removal of catheter is a patient at risk of catheter associated UTI?

Answer 19

24

Question 20

Women should be offered s____ in early pregnancy

Answer 20

screening

Question 21

True or false: asymptomatic bacteriuria should be treated in pregnant ladies

Answer 21

True

Question 22

What is pyelonephritis?

Answer 22

Infection of renal parenchyma and soft tissues of renal pelvis/ upper ureter

Question 23

Patients with pyelonephritis are often ___ depleted

Answer 23

fluid

Question 24

What is the classic triad of pyelonephritis symptoms?

Answer 24

Loin pain
Fever
Pyuria

Question 25

What are investigations for pyelonephritis

Answer 25

Abdominal exam:
Tender loin
Renal angle tenderness
PV (pelvic examination, rule out tubal/ovarian/appendix pathology)

Bloods including cultures

USS
MSU (midstream urine)

Question 26

How do you treat pyelonephritis?

Answer 26

Fluid replacement
IV antibiotics (co-amoxiclav possibly with gentamicin)
Drain obstructed kidney
Catheter
Analgesia

Question 27

What are characteristics of E. coli

Answer 27

Gram negative bacilli
Lactose fermenting

Question 28

What are complications of pyelonephritis?

Answer 28

Renal abscess

Emphysematous pyelonephritis (rare gas accumulation in tissues)